产科母婴同室产妇和陪护手卫生的重要性及健康教育有效途径

分析手卫生对于产科母婴同室的重要性,同时结合产科母婴同室临床护理及手卫生健康教育中存在的问题,探讨母婴同室产妇和陪护手卫生健康教育的有效方法途径,如加强护理人员能力培养,提高手卫生综合宣教水平。手卫生健康教育对于保证母婴同室的医疗护理安全具有极其重要的意义,因此要继续采取科学丰富的健康教育形式,向产妇、家属乃至社会更多层面的公众传播手卫生健康知识,以促进广大社会公众建立和养成全新的健康理念和行为习惯。     

改良护眼法在新生儿蓝光治疗中的应用

目的探讨改良护眼法在新生儿蓝光治疗中保护新生儿眼部的效果。方法选择新生儿病理性黄疸儿120例,随机分为改良组60例与对照组60例,改良组采用自制眼罩加用医用纱布敷料包裹,再在紧贴双眼部一面两侧各滴1²滴妥布霉素眼药水湿润后遮盖双眼部,对照组采用自制眼罩直接遮盖眼部,两组均采用3M胶布固定。对比2组患儿光疗24 h后眼部皮肤红肿、皮疹和眼睛分泌物的发生率。结果改良组的发生率明显低于对照组,2组差异具有统计学意义(p<0.05)。结论采用改良护眼法可有效保护眼睛,避免局部皮肤出现红肿、皮疹及眼部分泌物,提高患儿舒适感,推进优质护理服务。     

产前健康教育对产妇及新生儿的影响

目的：探讨孕妇在产前给予合理有效的健康教育对孕产妇以及新生儿健康影响分析。方法：选取本院2012年1月-2013年1月收治的220例围产期孕产妇作为研究对象,按照随机数字表法将其分为观察组和对照组各110例,所有孕妇均行基础产前准备与护理,观察组在此基础上在产前给予健康教育。观察比较两组孕产妇生活质量、产后出血量、抑郁程度、满意度之间的差异。结果：观察组产妇待产期生活质量明显高于对照组,产后出血量明显少于对照组,且抑郁程度明显低于对照组,母婴保健知识和对产科服务的满意度均明显高于对照组,差异均有统计学意义（P〈0.05）。结论：在孕妇产前给予合理有效的健康教育服务模式对于提高产科质量具有积极意义,综合护理干预可以有效提高产科护理水平,改善产妇待产期生活质量、降低产后出血量及抑郁水平,提高产妇对于母婴保健知识的掌握程度,增强其对产科服务的评价。     

腹腔镜诊治新生儿十二指肠梗阻 34 例临床分析简

目的：探讨腹腔镜诊治新生儿十二指肠梗阻（CDO）的疗效,总结经验教训。方法：回顾性分析34例经腹腔镜诊断手术的CDO患儿的临床资料。结果：34例患儿中20例肠旋转不良,1例因术中肠管损伤中转进腹,19例完成腹腔镜Ladd术;环状胰腺10例施行腹腔镜十二指肠侧侧菱形吻合术;4例十二指肠隔膜样狭窄予纵形切开肠壁,切除部分隔膜后横行缝合肠管。手术时间90＆#177;23.2min（45-210min）,术后3-5天进食,1例环状胰腺出现吻合口漏,经引流和静脉营养等治疗后痊愈。术后获得随访29例,随访3-18个月,1例肠旋转不良术后2个月出现粘连性肠梗阻,予对症治疗后自愈,所有患儿生长发育正常。结论：腹腔镜诊治CDO具有创伤小、恢复快、切口美观等优点,值得推广,但初期实施要注意避免手术并发症。     

Caudal anesthesia with sedation for inguinal hernia repair in high risk neonates

Background/Purpose

The use of caudal anesthesia with sedation (CAS) has theoretical benefits over general anesthesia (GA) in high risk neonates undergoing inguinal hernia repair. This benefit has not been established in clinical studies. We compare outcomes of these two approaches at a single institution.

Methods

A retrospective review was performed of all neonates and preterm infants undergoing inguinal hernia over an 8 year period.

Results

Of 71 infants meeting inclusion criteria, 50 underwent repair with caudal block and systemic sedation, and 21 with general anesthesia. Minor incidents of respiratory depression requiring non invasive interventions were common in the first 24 h post operatively (24% for CAS, 14% with GA), 4% of patients receiving CAS had a respiratory complication which prolonged their hospital stay beyond 24 h post operation. Both required conversion to general anesthesia. Statistically significant differences between the two groups were lacking in terms of preoperative risk and post operative outcome.

Conclusions

CAS is a safe, effective anesthetic option for high risk neonates undergoing inguinal hernia repair. Patients requiring conversion to GA from CAS may be at increased risk for complications. Large, randomized trials are needed to determine any benefit over GA.     

The effect of docosahexaenoic acid on bone microstructure in young mice and bone fracture in neonates

Background

As low bone mineral density is a risk factor for fracture in childhood, optimizing age appropriate bone mass is recommended and might lower the impact of bone loss related to age. Consumption of omega-3 polyunsaturated fatty acids (PUFAs), including eicosapentaenoic and docosahexaenoic (DHA) acids have been shown to beneficially modulate bone metabolism. The objective of this study was to determine the incidence of fracture in neonates receiving a fish compared with soybean oil–based intravenous lipid emulsion and evaluate the effect of varying dietary omega-3 PUFA consumption on growing bone in young mice.

Materials and methods

Eligibility criteria for the clinical study included gestational age ≤37 wk and parenteral nutrition–dependence for ≥4 wk. Radiographs were reviewed after lipid initiation to identify radiologic bone fracture. The animal study evaluated female C57/Bl6 mice randomized into one of five groups from age 3–12 wk, at which time femurs were harvested for micro–computed tomography and light microscopy analysis.

Results

A lower incidence of bone fracture was found in neonates maintained on fish compared with soybean oil. In the animal study, findings suggest the DHA diet provides the best protection against trabecular bone loss as evidenced by increased bone volume fraction, increased trabecular number, and decreased trabecular separation on micro–computed tomography. These protective effects appeared to affect the bone microstructure alone.

Conclusions

The lower fracture risk observed in fish oil fed neonates in combination with the protective effects of DHA observed in the femurs of young C57/BL6 mice suggest an important role for omega-3 PUFAs on bone growth.     

一氧化氮吸入联合高频震荡通气治疗新生儿严重呼吸衰竭的疗效分析

目的 探讨一氧化氮吸入(iNO)联合高频震荡通气(HFOV)治疗新生儿严重呼吸衰竭疗效。 方法 选取2013年3月至2016年3月60例HFOV中高参数设置下氧合差的患儿[吸入氧浓度(FIO₂)＞60%,经皮血氧饱和度(TcSO₂)＜80%],采用随机数字表法分为观察组及对照组,观察组予iNO联合HFOV治疗,对照组予单纯HFOV治疗,治疗中监测血气分析、血氧饱和度、血压、心率,监测血常规、出凝血时间、高铁血红蛋白等指标。比较两组的机械通气时间、救治成功率以及并发症发生率。 结果 iNO联合HFOV,能显著改善患儿氧合指数,使呼吸机参数逐渐下调至安全范围,且合理调整参数后患儿无明显不适,缩短患儿机械通气时间,提高呼吸衰竭患儿的抢救成功率。机械通气时间对照组为(107.00±39.60)h,观察组为(89.34±22.75)h,两组比较,差异有统计学意义(P＜0.05);死亡率对照组32.14%,观察组9.37%,两组比较,差异有统计学意义(P＜0.05)。观察组在未用iNO之前PH值、氧分压(PaO₂)、二氧化碳分压(PaCO₂)、动脉氧分压与吸入氧浓度比(PaO₂/FiO₂)、氧合指数(OI)值均差异无统计学意义(P＞0.05)。iNO后2 h、24 h比较差异有统计学意义(P＜0.05)。     

Imaging neonates within an incubator – A survey to determine existing working practice

IntroductionThere is limited and confusing evidence within the literature regarding the optimal techniques when imaging neonates within incubators; in particular, whether to place the image receptor directly behind the neonate or in the incubator tray. For this reason, radiology departments across Wales and North West England were surveyed to explore existing working practice with regards to incubator imaging.MethodA self-designed survey was developed using a systematic approach. The survey was sent to 31 radiology departments across Wales and North West England whom had a neonatal unit in order to assess existing techniques used when imaging neonates within the incubator. The survey was split into three main domains: 1) general/demographics, 2) exposure factors and technique, and 3) incubator design.ResultsNineteen departments responded (64%) demonstrating a wide variation in practice for incubator imaging. The minimum and maximum exposure factors used for neonatal chest x-ray imaging varied from 55 kV to 65 kV and 0.5 mAs–2 mAs. Fifty-eight percent of departments used the incubator tray as standard practice with the remaining forty two percent not using the tray for various reasons including, image quality, artefacts and misalignment. Sixty-three percent of departments use the maximum achievable SID for incubator imaging which demonstrates wide variability as the SID would be dependent upon: incubator design, portable machine and radiographer height.ConclusionThe survey demonstrates a wide variation in existing practice for neonatal incubator imaging.Implications for practiceThis study supports the need for standardisation and further optimisation work to ensure best practice for this vulnerable patient group.